2020 SHIELD Conference - Clinical Panel Nancy Klimas, MD - Nova Southeastern University
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2020 SHIELD Conference
Clinical Panel
Nancy Klimas, MD Alison Bested, MD IRINA ROZENFELD, Violetta Renesca, Denise Pryor Kruszynski,
Moderator MSHS, MSN, APRN DNP, APRN MSN, ARNP, FNP-BC
Gulf War Veterans
650,000 Service members served in
Operation Desert Shield and Desert Storm
from August 2, 1990 to July 31, 1991.
The Gulf War period is still in effect.
Anyone who served on active duty in
Southwest Asia from August 2, 1990, to
present is considered a Gulf War Veteran.
https://benefits.va.gov/PERSONA/veteran-gulfwar.asp
Chronic Multisymptom Illness
Many Gulf War Veterans are affected by a cluster of medically
unexplained chronic symptoms that can include fatigue,
headaches, joint pain, indigestion, insomnia, dizziness,
respiratory disorders, and memory problems.
VA refers to these illnesses as "chronic multisymptom illness,“
“medically unexplained illness,” or "undiagnosed illness."
Medically unexplained illness is presumed by the VA to be
related to military service in designated areas of Southwest Asia.
https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp
Presumptive Conditions
These "presumptive" illnesses must have appeared during
active duty in the Southwest Asia or by December 31, 2021, and
be at least 10 percent disabling. These illnesses include:
Myalgic Encephalomyelitis / Chronic Fatigue Syndrome
(ME/CFS)
Fibromyalgia
Functional gastrointestinal disorders
Undiagnosed illnesses
https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp
Functional
gastrointestinal Undiagnosed
Myalgic
disorders: illnesses:
Encephalomyeli
tis / Chronic irritable bowel other symptoms
Fibromyalgia: syndrome (IBS), like abnormal
Fatigue
Syndrome widespread functional weight loss,
(ME/CFS): muscle pain. dyspepsia, and muscle and joint
Other symptoms functional pain, headache,
fatigue not
may include abdominal pain neurological and
relieved by rest,
insomnia, syndrome. psychological
worsen by
fatigue, and Functional refers problems, skin
physical or
memory to a abnormal conditions,
mental activity
problems. function of an respiratory
and is not
organ, without disorders, and
caused by other
structural sleep
conditions.
alteration in disturbances.
tissue
Presumptive Conditions
https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp
How to talk to your doctor
about your health concerns
Or, how to get the best bang for your buck
during your next 10’ doctor’s appointment….
TIME IS PRECIOUS
Alison C. Bested MD, FRCPC, ABOIM
How to Inform Your Doctor
◦ Not all doctors are trained in conditions related to
deployment specifically in the Gulf War or any military
maneuvers
◦ Good news – doctors are quick learners and speed
readers!
◦ Doctors do know how to give supportive
symptomatic care.
7
Tips for Your Next Doctor’s
(Healthcare Providers’) Follow-up Visit
1. Come prepared
2. Organize yourself the day before your visit
3. Prioritize your needs
4. Write it down on a piece of paper (typed is best –
handwriting often not legible)
5. Copy your list and give one copy to your doctor
(speed reader)
8
Tips to help you have a more
Productive Visit with Your Doctor
1. Medications and Supplements
2. Symptoms – list 3 that have improved?
3. Problems/symptoms – list 3 today?
4. Referral – do you need one?
5. Forms – do you need a form completed?
9
Medications and Supplements
(Anything you put in your mouth or on your skin)
List of Medications and Supplements:
Ativan sublingual 0.5 mg nightly for sleep when needed
Multivitamin for men 1 tablet daily
Fish oil 1,000 mg 3X per day with food
Prescription Renewal
Ativan 0.5 mg nightly for sleep when needed. Bring empty
bottle.
10What has improved?
Music to my (the doctor’s) ears!
Make my day!
Celebrate the improvement!
Quantify the improvement.
Pain, sleep, anxiety, depression, etc.
11Improvements
Wong Baker Pain Scale
I was a 9/10 and now most days I’m a 5-6. That’s
fantastic!
What specifically helped? I went for a twenty minute
walk every day and stretched afterwards.
12What are your top 3 problems
you need help with? (Not all 16)
1. I can’t sleep. (describe it) I wake up feeling very hot every
night. It interrupts my sleep.
2. My wife of 20 years left me and my two teenage kids for
another woman.
3. I’ve lost 8 pounds in the last in the last 2 weeks.
13Referrals
Counselling
– what type: individual or group?
– who is available?
– where do I go?
– is there a cost?
– how is the referral made?
– long many times will I go for counselling?
14Forms
1. Date form needs to be completed by.
2. Complete all the details that you can.
3. Complex history – complete a copy with the details for the
doctor
so he won’t have to waste time going through the chart
for the
dates or medications in your history
15New Appointment
1. Bring a typed chronological summary of your medical
history including dates of past operations, exposures,
medications, smoking, drinking, physical, emotional
and sexual traumas, past medications to your first visit.
2. When did your illness start (deployment, infectious
disease, car accident) and how has it affected you –
sleep, pain, etc.
3. What were like and what were you able to do before
your illness that you can’t do now?
16Summary: Tips to Help You with
Your Next Doctor’s Appointment
1. Come prepared with written list
2. Medications and Supplements
3. Symptoms – list 3 that have improved?
4. Problems/symptoms – list 3 today?
5. Referral – do you need one?
6. Forms – do you need a form completed?
17Self-care/Wellness Techniques
Changing Perception and Attitude
Well-being
Scrum
therapy Regular Prebiotic
master
•Physical exam exercise foods
•Environmental Improving Removing
evaluation Sleep polutants
Eight
•Diet evaluation
•Review medication list Anti hours
•Psychology evaluation oxidants of sleep
•Spiritual support Treating
Healing Vitamins at
pre-existing Nutritional night
conditions modifications
Eliminated Work&Life
source of balance
stress
IRINA ROZENFELD, MSHS, MSN, APRN 18 IUseful Links Environment: https://www.ewg.org/ Nutrition: https://www.ewg.org/foodscore s/ Drug-induced nutrient deficiencies: https://mytavin.com/ Self-care links: https://www.healthjourneys.co m/app https://drwaynejonas.com/reso urces/
“Chronic disease requires an approach in which healing is as
important as curing. Where the focus is not just on countering illness
but also on supporting health—fully integrating preventative care and
self-care with the treatment of disease, illness and injury. That
approach is called integrative health” (Jonas, 2020).
◦ Former Director NIH Office of Alternative Medicine
◦ Former Director World Health Organization Center for Traditional Medicine
◦ Former Director of Medical Research Fellowship at
◦ Walter Reed Army Institute of Research
◦ Retired Lt. Colonel United States Army Medical Corps
◦ Practicing Family Physician at Fort Belvoir Community Hospital Pain Clinic
◦ Clinical Professor of Family Medicine, Georgetown University
◦ Executive Director of Samueli Integrative Health Programs
◦ www.samueliinstitute.org Dr. Wayne Jonas
Retrieved from https://drwaynejonas.com/Veterans Access Clinic
Who is Eligible for Services
Honorably discharged US Armed Forces Veterans with a DD-214, Army, Navy, Air Force Marine Corps, Coast Guard
Spouses and dependent, minor children are eligible for services
Preventative Care is Free of Charge
Medical office visits and evaluation for follow up care, including limited laboratory work
Dental visits for comprehensive exams, X-rays, cleaning, simple extractions, fillings (not covered: dentures, crowns, root canals, implants, braces)
Eye and Audiology exams
Physical therapy, occupational therapy and speech therapy
Psychological and behavioral counseling, Family and individual
Vision, Dental, Medication Allowances
Optometry - $500.00 benefit used towards eyeglasses or contacts. $200 towards low vision device
Audiology - $2000.00 benefit towards hearing aides
Medications – limited list of medications covered free of charge◦ Denise Kruszynski is a Family Nurse Practitioner
Denise Pryor positioned to treat her patients from a nursing as
well as a medical perspective.
Kruszynski, ◦ As a nurse, Denise approaches individuals with a
MSN, ARNP, holistic approach to meet them in physical,
emotional and spiritual dimensions to join with them
FNP-BC to explore how to best work towards achieving their
best heath.
NSU Veterans Access Clinic
Locations:
◦ Denise currently works seeing patients at the INIM
Fort Lauderdale/Davie Campus Clinic and NSU Veteran Access Clinic, including US
3200 South University Drive Armed Forces Veterans with a DD-214, spouses, and
dependent minor children, where preventative care
Sanford L. Ziff Health Care Center is free of charge
Fort Lauderdale, FL 33328-2018
(954)262-FLAG (3524), option 2
(954)262-FLAG (3524), option 2
Miami Campus
www.nova.edu/veterans
8501 SW 124th Avenue, Suite 111A
Miami, FL 33183-4631
email: veteransclinic@nova.edu
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